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Pension Plan Enrollment Form

Use this form to enroll as a participant in the New York State Nurses Association Pension Plan. In order to qualify, you must be a Registered Nurse who is a member of the New York State Nurses Association employed in a covered position at a participating facility. If you have questions about your eligibility, see your human resources department.

Option Election Form

Use this form when you retire to choose a retirement payment form. Normal forms of payment are Joint and Survivor (for married participants) and Five Year Certain (for single participants). Optional forms of payment are Ten Year Certain and Contingent Annuitant.

Preretirement Survivor Beneficiary Designation Form

Use this form to designate a beneficiary for your Preretirement Survivor Benefit, which is available if you die after you're vested, but before you retire. Your spouse automatically is designated as your PRSB beneficiary if you're married (you don't have to complete this form). Only complete this form if you are single, widowed, divorced, or if you and your spouse have waived the PRSB benefit. Click here for an explanation of this benefit. 

Direct Deposit Form

Use this form when you retire to enroll in the Pension Plan’s Direct Deposit program. The program allows pension payments to be deposited directly into checking or savings accounts which are at institutions that are in the United States and are registered with the Federal Reserve.

 Retiree Change of Address Form

Use this form when you are retired to advise the Plan of a change of address. If you're an active participant, e-mail change of address information to the Plan with your name, Social Security number, new address, facility name, marital status, spouse's name (if applicable), and phone number.

Pension Application Form

Use this form when you retire to supply information that will be used to prepare your pension calculation. (The Plan office sends Part 2 of the Pension Application form directly to your employer.)

IRS W-4P Form

Use this form when you retire to indicate whether income tax is to be withheld from your pension payment, and on what basis.